Cutoff Value of Admission N-Terminal Pro-Brain Natriuretic Peptide Which Predicts Poor Myocardial Perfusion after Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction

• Published in: Acta Cardiologica Sinica Vol. 32; no. 6; pp. 649 - 655
• Main Authors: Abdel-Dayem, Khairy, Eweda, Inas I, El-Sherbiny, Ashraf, Dimitry, Marc O, Nammas, Wail
• Format: Journal Article
• Language: English
• Published: 台灣 中華民國心臟學會 01.11.2016; Taiwan Society of Cardiology
• Subjects: Cad; MEDLINE; Myocardial blush grade; N-terminal pro-brain natriuretic peptide; Original; Primary percutaneous coronary intervention; SCI; Scopus; ST-segment resolution; ST-segment-elevation myocardial infarction; Myocardial blush grade; Primary percutaneous coronary intervention; ST-segment-elevation myocardial infarction; N-terminal pro-brain natriuretic peptide; ST-segment resolution
• ISSN: 1011-6842
• DOI: 10.6515/ACS20151112B

Background: We explored the value of admission levels of N-terminal pro-brain natriuretic peptide (NTProBNP) that best predicts poor myocardial tissue perfusion following primary percutaneous coronary intervention (PPCI) in patients admitted with acute ST-segment-elevation myocardial infarction (STEMI).＜BR＞Methods: We enrolled 90 consecutive patients admitted with acute STEMI who underwent PPCI and achieved post-procedural TIMI flow grade 3 in the infarct-related artery. We measured levels of NTProBNP from admission blood samples. Thereafter, we assessed post-procedural myocardial blush grade (MBG) at the end of PPCI, and further measured ST segment resolution (STR) 90 minutes following PPCI. The primary endpoint was STR ＜ 50%; furthermore, the co-primary angiographic endpoint was postprocedural MBG 0/1.＜BR＞Results: The mean age of study subjects was 53.6 10.9 years (74.4% males).We found that NTProBNP was higher in patients with STR ＜ 50% versus those with STR 50% (p ＜ 0.001), and in patients with post-procedural MBG 0/1 versus those with MBG 2/3 (p ＜ 0.001). A value of NTProBNP 420 ng/L was the optimal cutoff value that best predicted ＜ 50% STR; it predicted ＜ 50% STR with sensitivity, specificity, positive and negative predictive value of 98.4%, 92.3%, 96.9%, and 96%, respectively. Likewise, a value of NTProBNP 570 ng/Lwas the optimal cutoff value that best predicted postprocedural MBG 0/1; it predicted MBG 0/1 with sensitivity, specificity, positive and negative predictive value of 92.2%, 66.7%, 78.3%, and 86.7%, respectively.＜BR＞Conclusions: In patients with STEMI who underwent PPCI and ended up with successful recanalization of the epicardial infarct-related artery, elevated admission levels of NTProBNP predicted incomplete post-procedural STR with good sensitivity and specificity, and predicted poor post-procedural myocardial blush with good sensitivity and moderate specificity.